© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 15 Group Therapy, Family Therapy, and Couples Therapy

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Historically, applied – When heavy caseloads exist – As a supplemental technique Spiked with veterans post World War II

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Approaches Psychoanalytic – Free association – Transference – Interpretation of resistance – Group as a vehicle Increased anxiety tolerance

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Approaches Psychodrama – Form of role playing – Seeks catharsis – Done in a theatrical play format

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Approaches Transactional Analysis (TA): interactions among people of the group analyzed – 3 ego states Child Parent Adult – Each has a positive & negative aspects that patients can exhibit – Emphasis on games: Behaviors used to avoid getting close to others – Lack of research

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Approaches Gestalt – Residential seminars, retreats, workshops – Focus on 1 member at a time – “Hot seat” approach – Lacking research

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Approaches Behavioral – Efficiency over group dynamic – Reinforcement & problem solving – Therapist in didactic role – Time-limited – Research supported

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Arrangements Common factors – 5-10 members – 90 minute to 2 hour sessions – Weekly Can be mixed gender or separated One or more therapists – Can also be gender diverse Open vs. closed groups Group confidentiality

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Curative factors – Imparting information – Instilling hope – Universality – Altruism – Interpersonal learning – Imitative behavior – Corrective recapitulation – Catharsis – Group cohesiveness

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Does it work? – More efficient & economical – More effective than no treatment – Not shown to be superior to other treatments – Needs further research

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Group Therapy Looking ahead – Increasing demand – Influence of managed care – Alternative to inpatient treatment

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Background – Rooted in social work – Influencing individuals through the whole family unit; one person’s problem affects all members Double bind concept: A case in which an individual is told two contradictory messages by an important figure in his or her life such that every response he or she makes with regard to that figure is wrong Influence of schizophrenia studies: identified pathologic families

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Communication – Pathology is failure of communication – General systems theory: the family is a system, and pathology is reduced by altering the way the system functions – Focus on “unbalanced” state

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Forms/ methods – Multiple professions/ practitioners – Need for consensus of credentials for expert family therapists – Many theories and techniques used

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Goals – Improve communication – De-emphasize problems of individuals – Treat and view family as a whole

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Characteristics – Important for therapist to learn the family’s idiosyncratic subculture and frame of reference – Therapist remains detached and does not favor certain family members or factions – Family history and assessment crucial

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Approaches – Conjoint family therapy Entire family seen at once Therapist as – Relatively non-directive – Resource provider – Observer – Teacher

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Communication – 5 forms Placating Blaming Super reasonable Irrelevant Congruent

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Approaches – Concurrent One therapist Family meets with therapist in individual sessions Same goals as conjoint – Collaborative Multiple therapists Family seen individually, by different therapists Therapists discuss family as a whole

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Approaches – Behavioral Focus on reinforcement contingencies and skills training Full behavioral analysis of family problems Inducing family to provide correct reinforcement Similar to a CBT approach

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Approaches – Multisystemic Therapy (MST) Intervention for juvenile offenders Family = most important link in changing youth behavior Problems arise from multiple factors

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Approaches – MST Components – Treatment delivered in home/ school/ community – 24/7 therapist access – Low caseloads – MST therapists work in a team – Employ evidence based techniques – Track & log outcomes

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Family Therapy Applying family therapy – Most often begun when adolescent is principal patient – Family crisis – Value conflicts – Cost-benefit considerations

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Couples Therapy Background – Form of family therapy – Wide range of theoretical approaches – High rate of growth since 1960s

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Couples Therapy Behavioral Marital Therapy (BMT) – Application of reinforcement principles – Contingency contracting – Support-understanding technique – Problem-solving techniques

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Couples Therapy Emotionally Focused Therapy (EFT) – Brief treatment – Changes negative emotional interactional styles – Establish more secure attachment – 9 step process

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Emotionally Focused Couples Therapy

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Effectiveness High complexity; much harder to evaluate empirically Requires – Self reporting – Ratings by others – Observational ratings

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Effectiveness Family therapy – Relatively few well controlled studies – Eclectic and behavioral family therapy most effective – Superior with OCD & schizophrenia Couples therapy – Even fewer studies – BMT for lower distress – EFT for higher distress cases

© 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Effectiveness